This agency is an equal opportunity employer. Federal and State laws prohibit discrimination in employment practices because of race, color, religion, age, sex, national origin or non job-related hanicap or disability. No question on this application is asked for the purpose of excluding any applicant from consideration for employment because of his or her race, color, religion, age, sex, national origin or non job-related handicap or disability.

Please complete this form
and click on the send button at the bottom. Any information you provide to us
will be kept confidential - meaning we will not resell, share, lend or give any
of the following information you provide to us to any organization or person
outside of our company.

*Required Fields

status desired:

full time
part time
weekends

day shift
evening shift
night shift

DATE OF BIRTH:

NAME:

email address:

ADDRESS:

City:

Zip
Code:

PHONE #:

1.
last
job

employer:

supervisor:

Phone:

ending salary:

/ HR

Employed from:

to

full time
part time

reason for leaving:

explain duties and responsibilities:

2.
next to last
job

employer:

supervisor:

Phone:

ending salary:

/ HR

Employed from:

to

full time
part time

reason for leaving:

explain duties and responsibilities:

3.
job before above

employer:

supervisor:

Phone:

ending salary:

/ HR

Employed from:

to

full time
part time

reason for leaving:

explain duties and responsibilities:

may we contact your present employer?:

yes
no

have you ever applied for or received benefits for workmen's compensation or disability?:

yes
no

have you ever been sued or submitted a claim for professional liability?:

yes
no

If yes, please explain:

have you ever been convicted of a crime other than a misdemeanor or summary offensive?:

yes
no

if yes, please explain:

U.s. citizen?
yes
no may we do a criminal background check?

yes
no

education

name

from mo/yr

to mo/yr

yr graduated

major subject

degree

high school

nursing / college

vocational / bus.

personal references: other than former employers or relatives

name

occupation

address & phone

yrs
known

person to be notified in case of accident or emergency:

name

phone

relationship

I hereby authorize K&L Construction & Property, LLC and also authorize and request each former employer, person or corporation given as a reference, to give all information as it may be sought in connection with the application or concerning me, my work habits, character, skill or my action in any transaction. I agree in consideration of your employing me, that I will not seek or accept employment either directly or indirectly from any client of K&L Construction & Property, LLC, to whom I have been assigned, for at least 120 days after the last date of that assignment. I certify that the information herein is true and correct to the best of my knowledge and belief.